早期糖尿病周围神经病患者的EMG改变及其与血清脂蛋白相关磷脂酶A2水平的关系  

EMG change and its relationship with the serum level of lipoprotein-associated phospholipase A2 in patients with diabetic peripheral neuropathy in early stage

作　　者：张渭芳[1] 苏岑[1] 赵康仁[1] 任乃勇[1] ZHANG Wei-fang SU Cen ZHAO Kang-ren et al(Department of Neurology, the Fourth Affiliated Hospital of Jiangsu University, Zhenfiang 212001, China)

机构地区：[1]江苏大学附属四院神经内一科,镇江212001

出　　处：《临床神经病学杂志》2017年第5期358-361,共4页Journal of Clinical Neurology

基　　金：镇江市社会发展科技支撑项目(SH2013089;SH2015027)

摘　　要：目的探讨早期糖尿病周围神经病(DPN)患者的EMG改变及其与血清脂蛋白相关磷脂酶A2(Lp-PLA2)水平的关系。方法对90例早期DPN患者行EMG检查,测定内容包括双侧神经运动传导速度(MCV)、复合肌肉动作电位波幅(CMAP)、感觉传导速度(SCV)、感觉神经动作电位波幅(SNAP)及胫神经H波和尺神经f波,分析其与患者血清Lp-PLA2水平的关系。结果 90例早期DPN患者EMG检查总异常率为90.0%。早期DPN患者下肢运动神经异常率(68.6%)显著高于上肢异常率(24.5%)(χ~2=123.863,P=0.000)。早期DPN患者下肢感觉神经异常率(87.4%)显著高于上肢异常率(54.7%)(χ~2=82.712,P=0.000)。早期DPN患者感觉神经总异常率(71.1%)显著高于运动神经总异常率(46.5%)(χ~2=78.978,P=0.000)。DPN患者胫神经H反射总异常65例(72.2%),尺神经f波总异常14例(15.6%)。根据血清LpPLA2水平,90例早期DPN患者分为低水平组(36例)、中水平组(25例)和高水平组(29例)。与低水平组比较,中水平组及高水平组MCV、SCV异常率及CMAP、SNAP下降率均明显降低,且高水平组MCV、SCV异常率及CMAP、SNAP下降率均明显低于中水平组(均P<0.05)。Spearman秩相关分析结果显示,血清Lp-PLA2水平与MCV、SCV异常率及CMAP、SNAP下降率均呈负相关(r=-0.741,r=-0.773,r=-0.652,r=-0.611;均P<0.05)。结论 EMG检查对DPN早期诊断有重要价值,维持血清Lp-PLA2水平稳定对早期DPN的治疗可能有重要意义。Objective To investigate the EMG change and its relationship with the serum level of lipoproteinassociated phospholipase A2（ Lp-PLA2） in patients with diabetic peripheral neuropathy（ DPN） in early stage.Methods Ninety DPN patients in early stage were examined by EMG,including bilateral nerve conduction velocity（ MCV）,compound muscle action potential amplitude（ CMAP）,sensory conduction velocity（ SCV）,sensory nerve action potential amplitude（ SNAP）,tibial nerve H wave and ulnar nerve f wave. Then the relationship between EMG changes and serum levels of Lp-PLA2 was analyzed. Results The total abnormal rate of 90 DPN patients in early stage was 90. 0%. The abnormal rate of motor nerve in lower limbs of DPN patients in early stage（ 68. 6%） was significantly higher than that in upper limbs（ 24. 5%）（ χ^2= 123. 863,P = 0. 000）. The abnormal rate of sensory nerve in lower limbs of DPN patients in early stage（ 87. 4%） was significantly higher than that in upper limbs（ 54. 7%）（ χ^2= 82. 712,P = 0. 000）. The total abnormal rate of sensory nerve in DPN patients in early stage（ 71. 1%） was significantly higher than that in motor nerve（ 46. 5%）（ χ^2= 78. 978,P = 0. 000）. The total abnormal H reflex of tibial nerve was detceted in 65 cases（ 72. 2%）,and the total abnormal F wave of ulnar nerve was detected in 14 cases（ 15. 6%）. According to the serum level of Lp-PLA2,90 DPN patients in early stage were divided into low level group（ 36 cases）,middle level group（ 25 cases） and high level group（ 29 cases）. Comparing with the low level group of Lp-PLA2,abnormal rates of MCV and SCV and amplitude decreasing rates of CMAP and SNAP in the middle and high level group were all significantly decreased,while those rates in the high level group was significantly lower than those in the middle level group（ all P〈0. 0 5）. Spearman rank correlation analysis showed that serum Lp-PLA2 levels were negatively correlated with abnormal rates of MCV and SCV and am

关 键 词：糖尿病周围神经病 EMG 血清脂蛋白相关磷脂酶A2 

分 类 号：R587.2[医药卫生—内分泌] R747.9[医药卫生—内科学]